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      Implementación y funcionamiento de hogares protegidos para personas con trastornos mentales graves en Iquitos, Perú (2013-2016) Translated title: Implementation and operation of protected residences for people with serious mental illness in Iquitos, Peru (2013-2016) Translated title: Implementação e funcionamento de residências terapêuticas para pessoas com transtornos mentais graves em Iquitos, Peru (2013–2016)

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          RESUMEN

          Objetivo

          Evaluar el proceso de implementación y funcionamiento de los hogares protegidos para las personas con trastornos mentales graves en Iquitos, con base en el beneficio y la mejora en la calidad de vida percibida.

          Métodos

          Estudio con enfoque cualitativo y transversal. Se realizaron 36 entrevistas a profundidad a residentes del hogar, cuidadores, vecinos y profesionales de salud. Se llenó una ficha sociodemográfica y clínica por cada residente y una ficha de procesos de gestión por cada hogar protegido. Se realizaron grupos focales con gestores y cuidadores.

          Resultados

          El tiempo de estancia prolongada manicomial previa de los residentes de hogares protegidos fue de 7 años y 3 meses. Solo 28 % habían presentado recaída clínica durante el último año. Los residentes percibieron mejoría en su calidad de vida y mayor satisfacción en la estancia en hogar protegido respecto a la estancia manicomial previa. Los hogares evaluados se encuentran en lugares accesibles a servicios sociales y comunitarios, con adecuado acceso a medios de transporte. Se realizaron supervisiones periódicas a los cuidadores, infraestructura y mantenimiento del hogar.

          Conclusiones

          Existe percepción favorable de cuidadores, gestores, residentes y vecinos sobre el funcionamiento de los hogares protegidos.

          ABSTRACT

          Objective

          Evaluate the implementation and operation of protected residences for people with serious mental illness in Iquitos, based on the benefits and perceived improvement in their quality of life.

          Methods

          Qualitative and cross-cutting study. Thirty-six in-depth interviews of residents, caregivers, neighbors, and health professionals were conducted. A sociodemographic and clinical file was completed for each resident, along with a file on managerial processes for each facility. Focus groups were conducted with managers and caregivers.

          Results

          Residents' previous length of stay in a psychiatric hospital was 7 years and 3 months. Only 28 % had suffered a clinical relapse in the past year. Residents reported an improvement in their quality of life and greater satisfaction with their stay in the facility compared with their stay in the psychiatric hospital. The residences evaluated are located in areas accessible to social and community services, with adequate access to transportation. Periodic supervision of caregivers, infrastructure, and residence maintenance was performed.

          Conclusions

          Caregivers, managers, residents, and neighbors have a positive view of residence operations.

          RESUMO

          Objetivo

          Avaliar o processo de implementação e funcionamento de residências terapêuticas (“pensões protegidas”) para pessoas portadoras de transtornos mentais graves segundo a percepção de benefício e melhoria da qualidade de vida.

          Métodos

          Trata-se de um estudo transversal qualitativo realizado em Iquitos, no Peru. Trinta e seis entrevistas em profundidade foram conduzidas com os moradores de residências terapêuticas, cuidadores, vizinhos e profissionais de saúde. Foi feito o preenchimento de uma ficha sociodemográfica e clínica para cada morador e uma ficha do processo de gestão por residência. Foram realizados grupos de discussão com gestores e cuidadores.

          Resultados

          A permanência prolongada anterior em instituição manicomial dos moradores das residências foi de 7 anos e 3 meses. Apenas 28% tiveram recaída clínica no último ano. Os moradores perceberam melhoria da qualidade de vida e informaram um nível maior de satisfação com a permanência nas residências terapêuticas em comparação à permanência anterior em instituição manicomial. As residências estudadas se situavam em locais acessíveis aos funcionários dos serviços sociais e comunitários, com acesso adequado ao transporte público. O trabalho dos cuidadores e a infraestrutura e manutenção das residências receberam supervisão periódica.

          Conclusões

          O funcionamento das residências terapêuticas é percebido favoravelmente por cuidadores, gestores, moradores e vizinhos.

          Related collections

          Most cited references25

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          A review of research on residential programs for people with severe mental illness and co-occurring substance use disorders.

          Substance use disorder is the most common and clinically significant co-morbidity among clients with severe mental illnesses, associated with poor treatment response, homelessness and other adverse outcomes. Residential programs for clients with dual disorders integrate mental health treatment, substance abuse interventions, housing and other supports. Ten controlled studies suggest that greater levels of integration of substance abuse and mental health services are more effective than less integration. Because the research is limited by methodological problems, further research is needed to establish the effectiveness of residential programs, to characterize important program elements, to establish methods to improve engagement into and retention in residential programs and to clarify which clients benefit from this type of service.
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            Building effective service linkages in primary mental health care: a narrative review part 2

            Background Primary care services have not generally been effective in meeting mental health care needs. There is evidence that collaboration between primary care and specialist mental health services can improve clinical and organisational outcomes. It is not clear however what factors enable or hinder effective collaboration. The objective of this study was to examine the factors that enable effective collaboration between specialist mental health services and primary mental health care. Methods A narrative and thematic review of English language papers published between 1998 and 2009. An expert reference group helped formulate strategies for policy makers. Studies of descriptive and qualitative design from Australia, New Zealand, UK, Europe, USA and Canada were included. Data were extracted on factors reported as enablers or barriers to development of service linkages. These were tabulated by theme at clinical and organisational levels and the inter-relationship between themes was explored. Results A thematic analysis of 30 papers found the most frequently cited group of factors was "partnership formation", specifically role clarity between health care workers. Other factor groups supporting clinical partnership formation were staff support, clinician attributes, clinic physical features and evaluation and feedback. At the organisational level a supportive institutional environment of leadership and change management was important. The expert reference group then proposed strategies for collaboration that would be seen as important, acceptable and feasible. Because of the variability of study types we did not exclude on quality and findings are weighted by the number of studies. Variability in local service contexts limits the generalisation of findings. Conclusion The findings provide a framework for health planners to develop effective service linkages in primary mental health care. Our expert reference group proposed five areas of strategy for policy makers that address organisational level support, joint clinical problem solving, local joint care guidelines, staff training and supervision and feedback.
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              Supported Housing and Supported Independent Living in the Netherlands, with a Comparison with England

              Research into community housing programs for people with severe mental illness is underexposed. The Dutch UTOPIA study describes characteristics of their service users, which may predict their allocation to either supported housing or supported independent living programs. Additionally, a comparison is made with English studies. 119 Care coordinators of Dutch residential care institutes and 534 service users participated in a cross-sectional survey which includes socio-demographic data, clinical data, measures of functioning, needs for care and quality of life. Differences between Dutch residents and independent living service users were small, making predictions of care allocation difficult. This similarity suggests a possible lack of methodical assessment in the allocation procedure of people who are eligible for residential housing or independent living programs. This is largely comparable to the English situation. In comparison with their English counterparts, Dutch service users have more met needs and are more engaged in occupational activities.
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                Author and article information

                Journal
                Rev Panam Salud Publica
                Rev. Panam. Salud Publica
                rpsp
                Revista Panamericana de Salud Pública
                Organización Panamericana de la Salud
                1020-4989
                1680-5348
                10 October 2018
                2018
                : 42
                : e141
                Affiliations
                [1 ] originalInstituto Nacional de Salud Mental Honorio Delgado Hideyo Noguchi, Lima, Perú.
                [2 ] originalDirección Regional de Salud Loreto, Iquitos, Perú.
                [3 ] originalMinisterio de Salud del Gobierno de Perú, Lima, Perú.
                Author notes
                Enviar correspondencia a Vanessa Herrera Lopez, vanessaherrera7@ 123456hotmail.com

                Conflicto de intereses Ninguno declarado por los autores.

                Article
                RPSP.2018.141
                10.26633/RPSP.2018.141
                6385634
                cc3edcde-c9ea-4882-b244-c93aea9aae14

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 IGO License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited. No modifications or commercial use of this article are permitted. In any reproduction of this article there should not be any suggestion that PAHO or this article endorse any specific organization or products. The use of the PAHO logo is not permitted. This notice should be preserved along with the article's original URL.

                History
                : 13 April 2018
                : 10 July 2018
                Page count
                Figures: 0, Tables: 5, Equations: 0, References: 35
                Categories
                Investigación Original

                apoyo social,instituciones residenciales,trastornos mentales,reforma de la atención de salud,funcionamiento de los servicios,perú,social support,residential facilities,mental disorders,health care reform,services functioning,peru,apoio social,instituições residenciais,transtornos mentais,reforma dos serviços de saúde,funcionamento dos serviços

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